Meta-Analysis
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World J Gastroenterol. Sep 28, 2013; 19(36): 6098-6107
Published online Sep 28, 2013. doi: 10.3748/wjg.v19.i36.6098
Helicobacter pylori infection and esophageal cancer risk: An updated meta-analysis
Fa-Jun Xie, Yi-Ping Zhang, Qiu-Qing Zheng, Hong-Chuan Jin, Fa-Liang Wang, Ming Chen, Lan Shao, De-Hong Zou, Xin-Min Yu, Wei-Min Mao
Fa-Jun Xie, Yi-Ping Zhang, Lan Shao, Xin-Min Yu, Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, Zhejiang Province, China
Fa-Jun Xie, Qiu-Qing Zheng, Ming Chen, De-Hong Zou, Wei-Min Mao, Zhejiang Key Laboratory of Diagnosis and Treatment Technology on Thoracic Oncology (Lung and Esophagus), Hangzhou 310022, Zhejiang Province, China
Hong-Chuan Jin, Fa-Liang Wang, Laboratory of Cancer Biology, Sir Runrun Shaw Hospital, Medical School of Zhejiang University, Hangzhou 310029, Zhejiang Province, China
Author contributions: Xie FJ and Mao WM designed research; Zheng QQ and Wang FL collected and analyzed the data; Zhang YP and Shao L wrote the manuscript; Zou DH and Yu XM contributed to the discussion; Chen M and Jin HC contributed to the discussion and revised the manuscript.
Supported by China Postdoctoral Science Foundation, No. 2012M521189; Zhejiang Provincial Postdoctoral Science Foundation, No. Bsh1202064; National Natural Science Foundation of China, No. 81172081; Zhejiang Provincial Natural Science Foundation, No. LY13H160024; and Wu Jieping Medical Foundation, No. 2011, 3206750.11059 and 11091
Correspondence to: Wei-Min Mao, Professor, Zhejiang Key Laboratory of Diagnosis and Treatment Technology on Thoracic Oncology (Lung and Esophagus), No. 38 Guangji Road, Banshanqiao District, Hangzhou 310022, Zhejiang Province, China. maowm1318@163.com
Telephone: +86-571-88122182 Fax: +86-571-88122181
Received: June 14, 2013
Revised: July 29, 2013
Accepted: August 12, 2013
Published online: September 28, 2013
Processing time: 104 Days and 2.2 Hours
Abstract

AIM: To clarify the association between Helicobacter pylori (H. pylori) infection and the risk of esophageal carcinoma through a meta-analysis of published data.

METHODS: Studies which reported the association between H. pylori infection and esophageal cancer published up to June 2013 were included. The odds ratios (ORs) and corresponding 95%CIs of H. pylori infection on esophageal cancer with respect to health control groups were evaluated. Data were extracted independently by two investigators and discrepancies were resolved by discussion with a third investigator. The statistical software, STATA (version 12.0), was applied to investigate heterogeneity among individual studies and to summarize the studies. A meta-analysis was performed using a fixed-effect or random-effect method, depending on the absence or presence of significant heterogeneity.

RESULTS: No significant association between H. pylori infection and esophageal squamous cell carcinoma (ESCC) risk was found in the pooled overall population (OR = 0.97, 95%CI: 0.76-1.24). However, significant associations between H. pylori infection and ESCC risk were found in Eastern subjects (OR = 0.66, 95%CI: 0.43-0.89). Similarly, cytotoxin-associated gene-A (CagA) positive strains of infection may decrease the risk of ESCC in Eastern subjects (OR = 0.77, 95%CI: 0.65-0.92), however, these associations were not statistically significant in Western subjects (OR = 1.26, 95%CI: 0.97-1.63). For esophageal adenocarcinoma (EAC) the summary OR for H. pylori infection and CagA positive strains of infection were 0.59 (95%CI: 0.51-0.68) and 0.56 (95%CI: 0.45-0.70), respectively.

CONCLUSION: H. pylori infection is associated with a decreased risk of ESCC in Eastern populations and a decreased risk of EAC in the overall population.

Keywords: Helicobacter pylori; Esophageal carcinoma; Cancer risk; Meta-analysis

Core tip: Based on this meta-analysis, we found that Helicobacter pylori infection may have a protective effect against esophageal squamous cell carcinoma in Eastern populations and against esophageal adenocarcinoma in the overall population.